Do I need a pap smear if I have never had sex?

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Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:

Pap smears are used to detect changes (dysplasia) or cancer in the cervical tissue, which is most often caused by HPV (human papilloma virus). While HPV is a sexually transmitted disease, it is important to keep in mind that HPV can be transmitted through touching, rubbing, oral sex and other sexual activity, not just through penetrating, penile-vaginal intercourse. Therefore, any woman who has engaged in any type of sexual activity is at risk. Lesbians are also at risk, and should also have regular pap screening.

A pap test can also detect other problems, such as infection and inflammation, which may or may not cause symptoms for the woman.

While it is unlikely that a woman who has never engaged in any sexual activity would develop cervical dysplasia or cancer, the risk is not zero. The general recommendations are for pap testing to start within 3 years after starting intercourse, or starting at age 21, whichever comes first. So, women with no sexual activity should still begin pap smears at age 21. The American College of Obstetricians and Gynecologists does recommend that after 3 normal yearly tests, testing can be performed "less frequently" in a low risk individual at the discretion of her physician.